Healthcare Provider Details

I. General information

NPI: 1154594646
Provider Name (Legal Business Name): VINITA PATEL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2008
Last Update Date: 02/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3184 GRAND CONCOURSE 2A
BRONX NY
10458-1007
US

IV. Provider business mailing address

2 WOODLAND COURT
ROSLYN NY
11576
US

V. Phone/Fax

Practice location:
  • Phone: 347-271-8903
  • Fax: 347-271-8906
Mailing address:
  • Phone: 516-365-3701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number239644
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: